VimoSEWA Arogya Sanshodan

1. VimoSEWAArogya Sanshodan Baseline Findings Jan 2011

2. Today’s Presentation • Overview of Swasthya Sanshodan project • Summary of baseline findings • Analysis plan • Your feedback on data, analysis and use

3. Action Research – Why? • VimoSEWA claims 2007-9 • Primary illness 40% of claims • Hysterectomy top claim for rural women, avg age 37 • Effectiveness of health education • Longstanding SEWA activity, in different forms • Recent studies show impact on neonatal mortality • Can it work for primary care and hysterectomy?

4. Research Questions • Can health education reduce unnecessary hospitalisation for diarrhea and fever? • Incidence • Expenditure • Health seeking behaviour • What are the drivers of hysterectomy? • How does education impact on knowledge and response to hysterectomy and gynecological care? • Do insured members seek health care differently? • Does an education program work differently for the uninsured?

5. Intervention Design • Selected 28 sevikas who work where VimoSEWA/LSM active • Randomly selected 14 sevikas to implement health education • Focus on diarrhea, malaria/fever and hysterectomy • Film, games and demonstrations • Capacity building and regular feedback • Over 2 years, 5 survey rounds amongst insured and uninsured to capture health seeking behavior

6. Study Coverage • 70 HH sampled in each cluster • 35 uninsured – from area listing • 35 insured – from Vimo MIS

7. HH Profile

8. Education: % ever studied

9. Respondent Profile

10. Women’s Work

11. Housing : % HH by Type

12. Household Toilets

13. Drinking Water

14. Mosquito precautions

15. Ration Cards/BPL

16. SEWA Health Services

17. VimoSEWA Services

18. VimoSEWA Coverage

19. HH with anyone ill – last month

20. Illness Rates – last month

21. Leading Illnesses - Women

22. Place of OPD Treatment Avg private exp: Rs. 380 Avg private exp: Rs. 501 Primarily private care, but less so in city Note slight differences within HH

23. % HH reported hospitalisation in last 6 months

24. Hospitalisation per 100; last 6 mos.Rural and Urban

25. Hospitalisation amongst women Rural Urban

26. Rates: Rural Vimo/Non-insured

27. Rates: Urban Vimo/Non-insured

28. Where Hospitalised - All Rural Urban

29. Place of Hospitalisation

30. Expenditure – Vimo and NV

31. Are VimoSEWA members different? DIFFERENCES • SES – only urban • More salaried • Higher exp • More pucca houses • Demographic • More widows • Less educated (urban) • Much more likely to have a ration card SIMILARITIES • SES • Income • Toilets • Housing (rural) • Demographic • HH size • Family structure

32. Reproductive Health Rural Urban

33. Hysterectomy

34. Age at hysterectomy

35. Hysterectomy Reasons

36. Place of Hysterectomy

37. Analysis Plan Baseline • Women’s illnesses and health seeking behaviour • Insured and Uninsured • Social Determinants of Health Overall • Impact of health education – with qualitative • Hysterectomy – with qualitative • Community health workers – performance and roles